Provider Demographics
NPI:1942441134
Name:LEWIS, KATHERINE C (BCBA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:C
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:C
Other - Last Name:MASINCUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4503 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1821
Mailing Address - Country:US
Mailing Address - Phone:540-505-2486
Mailing Address - Fax:
Practice Address - Street 1:5400 BYRDHILL RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5807
Practice Address - Country:US
Practice Address - Phone:804-387-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-05-2590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst